Dynamic 3d lung map view for tool navigation inside the lung

ABSTRACT

A method for implementing a dynamic three-dimensional lung map view for navigating a probe inside a patient&#39;s lungs includes loading a navigation plan into a navigation system, the navigation plan including a planned pathway shown in a 3D model generated from a plurality of CT images, inserting the probe into a patient&#39;s airways, registering a sensed location of the probe with the planned pathway, selecting a target in the navigation plan, presenting a view of the 3D model showing the planned pathway and indicating the sensed location of the probe, navigating the probe through the airways of the patient&#39;s lungs toward the target, iteratively adjusting the presented view of the 3D model showing the planned pathway based on the sensed location of the probe, and updating the presented view by removing at least a part of an object forming part of the 3D model.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.17/199,433 filed Mar. 11, 2021, now allowed, which is a continuation ofU.S. patent application Ser. No. 17/068,820, filed Oct. 12, 2020, nowU.S. Pat. No. 11,389,247, which is a continuation of U.S. patentapplication Ser. No. 16/828,947, filed Mar. 24, 2020, now U.S. Pat. No.10,799,297, which is a continuation of U.S. patent application Ser. No.16/418,495, filed May 21, 2019, now U.S. Pat. No. 10,646,277, which is acontinuation of U.S. patent application Ser. No. 16/148,174, filed Oct.1, 2018, now U.S. Pat. No. 10,660,708, which is a continuation of U.S.patent application Ser. No. 15/828,551, filed Dec. 1, 2017, now U.S.Pat. No. 10,105,185, which is a continuation of U.S. patent applicationSer. No. 15/447,472, filed Mar. 2, 2017, now U.S. Pat. No. 9,848,953,which is a continuation of U.S. patent application Ser. No. 14/751,257,filed Jun. 26, 2015, now U.S. Pat. No. 9,603,668, which claims thebenefit of the filing date of provisional U.S. Patent Application No.62/020,262, filed Jul. 2, 2014.

BACKGROUND Technical Field

The present disclosure relates to the treatment of patients with lungdiseases and, more particularly, to devices, systems, and methods forimplementing a dynamic 3D lung map view for tool navigation inside apatient's lungs.

Description of Related Art

Lung cancer has an extremely high mortality rate, especially if it isnot diagnosed in its early stages. The National Lung Screening Trial hasdemonstrated that a reduction in mortality occurs if diagnostic scanssuch as computed tomography (CT) scans are used for early detection forthose at risk of contracting the disease. While CT scans increase thepossibility that small lesions and nodules in the lung can be detected,these lesions and nodules still require biopsy and cytologicalexamination before a diagnosis can be rendered and treatment can beundertaken.

To perform a biopsy, as well as many treatments, navigation of toolswithin the lungs to the point of biopsy or treatment is necessary.Accordingly, improvements to systems and methods of navigating arecontinually being sought.

SUMMARY

Provided in accordance with the present disclosure is a method forimplementing a dynamic three-dimensional (3D) lung map view fornavigating a probe inside a patient's lungs.

In an aspect of the present disclosure, the method includes loading anavigation plan into a navigation system, the navigation plan includinga planned pathway shown in a 3D model generated from a plurality of CTimages, inserting the probe into a patient's airways, the probeincluding a location sensor in operative communication with thenavigation system, registering a sensed location of the probe with theplanned pathway, selecting a target in the navigation plan, resenting aview of the 3D model showing the planned pathway and indicating thesensed location of the probe, navigating the probe through the airwaysof the patient's lungs toward the target, iteratively adjusting thepresented view of the 3D model showing the planned pathway based on thesensed location of the probe, and updating the presented view byremoving at least a part of an object forming part of the 3D model.

In another aspect of the present disclosure, iteratively adjusting thepresented view of the 3D model includes zooming in when the probeapproaches the target.

In yet another aspect of the present disclosure, iteratively adjustingthe presented view of the 3D model includes zooming in when the diameterof an airway within which the probe is sensed to be located is less thana predetermined threshold.

In another aspect of the present disclosure, iteratively adjusting thepresented view of the 3D model includes changing the presented view to aview wherein the airway tree bifurcation is maximally spread.

In yet another aspect of the present disclosure, iteratively adjustingthe presented view of the 3D model includes aligning the view with thesensed location of the probe to show where the probe is and what liesahead of the probe.

In another aspect of the present disclosure, iteratively adjusting thepresented view of the 3D model includes changing the presented view tobe orthogonal to a vector from the probe to the pathway.

In yet another aspect of the present disclosure, iteratively adjustingthe presented view of the 3D model includes changing the presented viewto be perpendicular to the sensed location of the probe in relation tothe 3D model to show the area around the probe.

In another aspect of the present disclosure, iteratively adjusting thepresented view of the 3D model includes changing the presented view tobe behind the sensed location of the probe in relation to the 3D modelto show the area ahead of the probe.

In yet another aspect of the present disclosure, iteratively adjustingthe presented view of the 3D model includes changing the presented viewto be at the tip of the probe and orthogonal to the directing in whichthe probe is moving.

In another aspect of the present disclosure, iteratively adjusting thepresented view of the 3D model includes changing the presented view tobe perpendicular to a vector from the probe to the target to show thealignment of the probe to the target.

In yet another aspect of the present disclosure, iteratively adjustingthe presented view of the 3D model includes rotating the presented viewaround a focal point to improve a 3D perception of the sensed locationof the probe in relation to the 3D model.

In a further aspect of the present disclosure, updating the presentedview by removing at least part of an object includes removing at leastpart of an object which is outside of a region of interest.

In yet a further aspect of the present disclosure, updating thepresented view by removing at least part of an object includes removingat least part of an object which is obstructing the probe.

In a further aspect of the present disclosure, updating the presentedview by removing at least part of an object includes removing at leastpart of an object which is obstructing the target.

In yet a further aspect of the present disclosure, updating thepresented view by removing at least part of an object includes removingat least part of an object which is not relevant to the sensed locationof the probe.

In a further aspect of the present disclosure, updating the presentedview by removing at least part of an object includes removing at leastpart of an object which is not relevant to a current selected state ofthe navigation system.

In another aspect of the present disclosure, the method further includespresenting an alert.

In a further aspect of the present disclosure, presenting an alertincludes presenting an alert when the probe is approaching the pleura.

In yet a further aspect of the present disclosure, presenting an alertincludes presenting an alert when the tool is approaching major bloodvessels.

In a further aspect of the present disclosure, presenting an alertincludes presenting an alert when the sensed location of the probe isoff of the planned pathway.

Any of the above aspects and embodiments of the present disclosure maybe combined without departing from the scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and features of the present disclosure are describedhereinbelow with references to the drawings, wherein:

FIG. 1 depicts a system diagram of an example electromagnetic navigation(EMN) system which may be used to create and display a dynamic 3D lungmap view, according to an embodiment of the present disclosure;

FIG. 2 depicts a schematic diagram of an example workstation formingpart of the EMN system of FIG. 1 which may be used to create and displaya dynamic 3D lung map view, according to an embodiment of the presentdisclosure;

FIG. 3 is a flowchart illustrating an example method for creating adynamic 3D lung map view, according to an embodiment of the presentdisclosure;

FIG. 4 illustrates an example view of a user interface that may bepresented on the workstation of FIG. 2 showing an example of a dynamic3D lung map view, according to an embodiment of the present disclosure;

FIG. 5 illustrates an example of an unadjusted 3D lung map view,according to an embodiment of the present disclosure;

FIG. 6 illustrates an example of a dynamic 3D lung map view, accordingto an embodiment of the present disclosure; and

FIG. 7 illustrates another example of a dynamic 3D lung map view,according to an embodiment of the present disclosure.

DETAILED DESCRIPTION

Devices, systems, and methods for implementing a dynamic 3D lung mapview for tool navigation inside a patient's lungs are provided inaccordance with the present disclosure. A location sensor may beincorporated into different types of tools and catheters to track thelocation and assist in navigation of the tools. The tracked location ofthe location sensor may be used to visually show the location of a toolon the dynamic 3D lung map. The location of the location sensor withinthe body of a patient, with reference to a 3D map or 2D images as wellas a planned pathway assists the clinician in navigating lungs of thepatient. However, because of the amounts of data being presented and theability to show details of the airways, there is a desire to assist theclinician and eliminate unessential data or data regarding portions ofthe anatomy that are unrelated to a specific navigation or a specificprocedure. In addition, there is a desire to harness this detailedanatomical data and alert the clinician regarding proximity to certainanatomical features. These and other aspects of the present disclosureare detailed herein below.

The dynamic 3D lung map view, as disclosed herein, is one of a varietyof views that may be presented by an electromagnetic navigation (EMN)system which may be used by a clinician to perform an ELECTROMAGNETICNAVIGATION BRONCHOSCOPY® (ENB) procedure. Among other tasks that may beperformed using the EMN system are planning a pathway to target tissue,navigating a positioning assembly to the target tissue, and navigating avariety of tools, such as a locatable guide (LG) and/or a biopsy tool tothe target tissue.

An ENB procedure generally involves at least two phases: (1) planning apathway to a target located within, or adjacent to, the patient's lungs;and (2) navigating a probe to the target along the planned pathway.These phases are generally referred to as (1) “planning” and (2)“navigation.” An example of the planning software described herein canbe found in U.S. patent application Ser. Nos. 13/838,805, 13/838,997,and 13/839,224, all of which are filed by Covidien LP on Mar. 15, 2013and entitled “Pathway Planning System and Method,” all of which areincorporated herein by reference. An example of the planning softwarecan be found in commonly assigned U.S. Provision Patent Application No.62/020,240 entitled “SYSTEM AND METHOD FOR NAVIGATING WITHIN THE LUNG”the entire contents of which are incorporated herein by reference.

Prior to the planning phase, the patient's lungs are imaged by, forexample, a computed tomography (CT) scan, although additional applicablemethods of imaging will be known to those skilled in the art. The imagedata assembled during the CT scan may then be stored in, for example,the Digital Imaging and Communications in Medicine (DICOM) format,although additional applicable formats will be known to those skilled inthe art. The CT scan image data may then be loaded into a planningsoftware application (“application”) to be used during the planningphase of the ENB procedure.

The application may use the CT scan image data to generate athree-dimensional (3D) model of the patient's lungs. The 3D model mayinclude, among other things, a model airway tree corresponding to theactual airways of the patient's lungs, and showing the various passages,branches, and bifurcations of the patient's actual airway tree.Additionally, the 3D model may include lesions, markers, blood vessels,and/or a 3D rendering of the pleura. While the CT scan image data mayhave gaps, omissions, and/or other imperfections included in the imagedata, the 3D model is a smooth representation of the patient's airways,with any such gaps, omissions, and/or imperfections in the CT scan imagedata filled in or corrected. As described in more detail below, the 3Dmodel may be viewed in various orientations. For example, if a cliniciandesires to view a particular section of the patient's airways, theclinician may view the 3D model represented in a 3D rendering and rotateand/or zoom in on the particular section of the patient's airways.Additionally, during the navigation phase of an ENB procedure, while atool is being navigated through the patient's airways, the clinician maywant to have the presented view of the 3D model dynamically updated asthe tool is navigated. Such a dynamic 3D lung map view is disclosedbelow.

Prior to the start of the navigation phase of an ENB procedure, the 3Dmodel is registered with the actual lungs of the patient. One potentialmethod of registration involves navigating a locatable guide into eachlobe of the patient's lungs to at least the second bifurcation of theairways of that lobe. The position of the locatable guide is trackedduring this registration phase, and the 3D model is iteratively updatedbased on the tracked position of the locatable guide within the actualairways of the patient's lungs. This registration process is describedin commonly-owned U.S. Provisional Patent Application Ser. No.62/020,220 entitled “Real-Time Automatic Registration Feedback”, filedon Jul. 2, 2014, by Brown et al. With reference to FIG. 1 , an EMNsystem 10 is provided in accordance with the present disclosure. Onesuch EMN system is the ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY® systemcurrently sold by Covidien LP. As shown in FIG. 1 , EMN system 10generally includes an operating table 40 configured to support apatient; a bronchoscope 50 configured for insertion through thepatient's mouth and/or nose into the patient's airways; monitoringequipment 60 coupled to bronchoscope 50 for displaying video imagesreceived from bronchoscope 50; a tracking system 70 including a trackingmodule 72, a plurality of reference sensors 74, and an electromagneticfield generator 76; a workstation 80 including software and/or hardware,such as an EMN application 81, used to facilitate pathway planning,identification of target tissue, and navigation to the target tissue.

FIG. 1 also depicts two types of catheter guide assemblies 90, 100. Bothcatheter guide assemblies 90, 100 are usable with the EMN system 10 andshare a number of common components. Each catheter guide assembly 90,100 includes a handle 91, which is connected to an extended workingchannel (EWC) 96. EWC 96 is sized for placement into the working channelof bronchoscope 50. In operation, a locatable guide (LG) 92, includingan electromagnetic (EM) sensor 94, is inserted into EWC 96 and lockedinto position such that the sensor 94 extends a desired distance beyondthe distal tip 93 of EWC 96. The location of EM sensor 94, and thus thedistal end of EWC 96, within an electromagnetic field generated by theelectromagnetic field generator 76 can be derived by the tracking module72, and the workstation 80. Catheter guide assemblies 90, 100 havedifferent operating mechanisms, but each contain a handle 91 that can bemanipulated by rotation and compression to steer the distal tip 93 of LG92 and EWC 96. Catheter guide assemblies 90 are currently marketed andsold by Covidien LP under the name SUPERDIMENSION® Procedure Kits,similarly catheter guide assemblies 100 are currently sold by CovidienLP under the name EDGE™ Procedure Kits, both kits include a handle 91,EWC 96, and LG 92. For a more detailed description of the catheter guideassemblies 90, 100, reference is made to commonly-owned U.S. patentapplication Ser. No. 13/836,203 entitled “MICROWAVE ABLATION CATHETERAND METHOD OF UTILIZING THE SAME”, filed on Mar. 15, 2013 by Ladtkow etal., the entire contents of which are hereby incorporated by reference.

As illustrated in FIG. 1 , the patient is shown lying on operating table40 with bronchoscope 50 inserted through the patient's mouth and intothe patient's airways. Bronchoscope 50 includes a source of illuminationand a video imaging system (not explicitly shown) and is coupled tomonitoring equipment 60, e.g., a video display, for displaying the videoimages received from the video imaging system of bronchoscope 50.

Catheter guide assemblies 90, 100 including LG 92 and EWC 96 areconfigured for insertion through a working channel of bronchoscope 50into the patient's airways (although the catheter guide assemblies 90,100 may alternatively be used without bronchoscope 50). LG 92 and EWC 96are selectively lockable relative to one another via a locking mechanism99. A six degrees-of-freedom electromagnetic tracking system 70, e.g.,similar to those disclosed in U.S. Pat. No. 6,188,355 and published PCTApplication Nos. WO 00/10456 and WO 01/67035, entitled “Wirelesssix-degree-of-freedom locator”, filed on Dec. 14, 1998 by Gilboa, theentire contents of each of which is incorporated herein by reference, orany other suitable positioning measuring system, is utilized forperforming navigation, although other configurations are alsocontemplated. Tracking system 70 is configured for use with catheterguide assemblies 90, 100 to track the position of EM sensor 94 as itmoves in conjunction with EWC 96 through the airways of the patient, asdetailed below.

As shown in FIG. 1 , electromagnetic field generator 76 is positionedbeneath the patient. Electromagnetic field generator 76 and theplurality of reference sensors 74 are interconnected with trackingmodule 72, which derives the location of each reference sensor 74 in sixdegrees of freedom. One or more of reference sensors 74 are attached tothe chest of the patient. The six degrees of freedom coordinates ofreference sensors 74 are sent to workstation 80, which includes EMNapplication 81 where sensors 74 are used to calculate a patientcoordinate frame of reference.

Also shown in FIG. 1 is a biopsy tool 102 that is insertable intocatheter guide assemblies 90, 100 following navigation to a target andremoval of LG 92. The biopsy tool 102 is used to collect one or moretissue sample from the target tissue. As detailed below, biopsy tool 102is further configured for use in conjunction with tracking system 70 tofacilitate navigation of biopsy tool 102 to the target tissue, andtracking of a location of biopsy tool 102 as it is manipulated relativeto the target tissue to obtain the tissue sample. Though shown as abiopsy tool in FIG. 1 , those of skill in the art will recognize thatother tools including for example microwave ablation tools and othersmay be similarly deployed and tracked as the biopsy tool 102 withoutdeparting from the scope of the present disclosure.

Although the EM sensor 94 is described above as being included in LG 92it is also envisioned that EM sensor 94 may be embedded or incorporatedwithin biopsy tool 102 where biopsy tool 102 may alternatively beutilized for navigation without need of LG 92 or the necessary toolexchanges that use of LG 92 requires. A variety of useable biopsy toolsare described in U.S. Provisional Patent Application Nos. 61/906,732 and61/906,762 both entitled “DEVICES, SYSTEMS, AND METHODS FOR NAVIGATING ABIOPSY TOOL TO A TARGET LOCATION AND OBTAINING A TISSUE SAMPLE USING THESAME”, filed Nov. 20, 2013 and U.S. Provisional Patent Application No.61/955,407 having the same title and filed Mar. 14, 2014, the entirecontents of each of which are incorporated herein by reference anduseable with the EMN system 10 as described herein.

During procedure planning, workstation 80 utilizes computed tomographic(CT) scan image data for generating and viewing a three-dimensional (3D)model of the patient's airways, enables the identification of targettissue on the 3D model (automatically, semi-automatically or manually),and allows for the selection of a pathway through the patient's airwaysto the target tissue. The 3D model may be presented on a display monitorassociated with workstation 80, or in any other suitable fashion.

Using workstation 80, various views of the 3D model may be presented andmay be manipulated by a clinician to facilitate identification of atarget and selection of a suitable pathway through the patient's airwaysto access the target. For example, EMN application 81 may be configuredin various states to display the 3D model in a variety of view modes.Some of these view modes may include a dynamic 3D lung map view, asfurther described below. For each view of the 3D model, the angle fromwhich the 3D model is displayed may correspond to a view point. The viewpoint may be fixed at a predefined location and/or orientation, or maybe adjusted by the clinician operating workstation 80.

The 3D model may also show marks of the locations where previousbiopsies were performed, including the dates, times, and otheridentifying information regarding the tissue samples obtained. Thesemarks may also be selected as the target to which a pathway can beplanned. Once selected, the pathway is saved for use during thenavigation procedure.

Following procedure planning, a procedure may be undertaken in which theEM sensor 94, in conjunction with tracking system 70, enables trackingof EM sensor 94 (and thus the distal end of the EWC or the tool 102) asEM sensor 94 is advanced through the patient's airways following thepathway planned during the procedure planning phase.

Turning now to FIG. 2 , there is shown a system diagram of workstation80. Workstation 80 may include memory 202, processor 204, display 206,network interface 208, input device 210, and/or output module 212.Memory 202 may store EMN application 81 and/or CT data 214. EMNapplication 81 may, when executed by processor 204, cause display 206 topresent user interface 216. The EMN application 81 provides theinterface between the sensed position of the EM sensor 94 and the imageand planning data developed in the planning phase.

Referring now to FIG. 3 , there is shown an aspect which may beincorporated into an EMN application 81. Specifically, FIG. 3 depicts aflowchart of an exemplary method of creating a dynamic 3D lung map view.During an ENB procedure, this example method may be started when aclinician selects a dynamic 3D lung map view button 402 in an EMNapplication 81 user interface 400. Alternatively, button 402 may be adrop down menu from which the clinician may select the dynamic 3D lungmap view from among a plurality of available views. Starting at stepS302, the view point from which the 3D model is displayed may beautomatically adjusted in relation to the tracked location of a tool,which is depicted as a probe 406 in FIGS. 4-7 , inside the patient'slungs. Adjusting the view point may include moving the view point inrelation to the 3D model and/or zooming in on the 3D model to display acloser image of the 3D model. As shown in FIG. 6 below, an unadjusted 3Dlung map view (FIG. 5 ) is adjusted such that the position of a probe406 is more clearly shown in relation to the position of a target 510and surrounding airways 512. The view point may further be adjustedaccording to the direction in which probe 406 is being navigated and/orto be orthogonal to a vector between the tip of probe 406 and a target510 or in relation to the pathway 408, as is shown in FIGS. 6 and 7 ,which depict the 3D model from a view point orthogonal to vector 614which runs from the tip of digital probe 406 to target 510. The viewpoint may further be adjusted by zooming in when probe 406 approachestarget 510 or airways having a diameter less than a predeterminedthreshold. In an embodiment, a preferred view point may be such that thedisplayed view of the 3D model shows the bifurcations of the airway treearound digital probe 406 as maximally spread, that is, a view point froma direction showing the airway tree with as few overlapping branches aspossible. In an embodiment the view point may be moved to be above probe406 in relation to the 3D model, or behind probe 406 in relation to the3D model, in order to provide the clinician with a clearer understandingof the position of probe 406 in relation to surrounding objects. In suchan embodiment, the dynamic 3D lung map view may show the area of the 3Dmodel in front of and around the tool, as shown in FIG. 7 . In anotherembodiment, the view point may be moved such that the view presented byEMN application 81 is looking ahead out of the tip of digital probe 406.

Next, at step S304, EMN application 81 determines whether any objectsare visible from the current view point but are outside of a region ofinterest for the current navigation procedure. An example might be othertargets, or portions of the patient's physiology, such as blood vesselsand the heart, which lie outside of the region in which the pathway islocated, such as in other lobes of the patient's lungs, or along otherbranches of airway tree 404 which are not used for the currentprocedure. If EMN application 81 determines that such objects arevisible, those objects may be removed from the view at step S306, asshown below by FIG. 7 .

Thereafter, or if EMN application 81 determines that there are no suchobjects in the view, processing proceeds to step S308, where EMNapplication 81 determines whether there are objects obstructing the viewof digital probe 406 and/or target 510. For example, depending on theangle of the view point, the surrounding airways which do not form partof the planned pathway may lie in the line of sight and between the viewpoint and probe 406 or target 510. If EMN application 81 determines thatsuch objects are obstructing the view of probe 406 or target 510, thoseobjects may be removed from the view at step S310, as shown below byFIG. 7 .

Thereafter, or if EMN application 81 determines that there are no suchobjects in the view, processing proceeds to step S312, where EMNapplication 81 determines if there are any objects visible in the viewwhich are unrelated to the position of probe 406, the type of tool beingused in the current navigation procedure, or the selected state of EMNapplication 81. For example, markers indicating the location of previousbiopsies at different target locations may be within the view angle fromthe view point, but are not relevant to the current procedure, as shownbelow by FIG. 7 . Another example may be targets 722 which are part ofthe current navigation plan but have at least one other target 510 whichmust be visited first. Such targets 722 may become visible or “unhidden”once target 510 has been visited and the necessary procedures performed.If EMN application 81 determines that such objects are within the view,those objects may be removed from the view at step S314.

Thereafter, or if EMN application 81 determines that there are no suchobjects in the view, processing proceeds to step S316, where EMNapplication 81 determines whether digital probe 406, and thus sensor 94,is approaching the pleural boundaries of the patient's lungs. EMNapplication 81 may determine that sensor 94 is approaching the pleuralboundaries of the patient's lungs based on, for example, the distancebetween sensor 94 and the pleura, the angle between sensor 94 and thepleura, the speed at which sensor 94 is moving, and/or any combinationthereof. The determination may further be based on a known or estimatedrate of navigational errors. When sensor 94 is close to the pleura,there is an increased risk of injury, such as pneumothorax, to thepatient, and the clinician may want to be aware of that to proceed withadded caution. Thus, if EMN application 81 determines that sensor 94 isclose to the pleura, EMN application 81 may present an alert to theclinician at step S318. EMN application 81 may also take known orestimated navigational errors into account when determining whethersensor 94 is approaching the pleura.

Thereafter, or if EMN application 81 determines that sensor 94 is notapproaching the pleura, processing proceeds to step S320, where EMNapplication 81 determines whether sensor 94 is approaching one or moremajor blood vessels. As with the pleura, when sensor 94 is close tomajor blood vessels, particularly where a tool 102, such as a biopsy ormicrowave ablation tool, is being deployed, there is added risk ofinjury to the patient, and the clinician may want to be aware thatsensor 94 is close to major blood vessels to proceed with added caution.Thus, if EMN application 81 determines that sensor 94 is close majorblood vessels, EMN application 81 may present an alert to the clinicianat step S322. Additionally, as with the pleura, EMN application 81 maytake known or estimated navigational errors into account whendetermining whether sensor 94 is approaching major blood vessels.

Thereafter, or if EMN application 81 determines that sensor 94 is notapproaching any major blood vessels, processing proceeds to step S324,where EMN application 81 determines whether probe 406 has arrived at thetarget. If EMN application 81 determines that probe 406 has not arrivedat the target, processing returns to step S302. In this way, the dynamic3D lung map view is continuously updated and/or adjusted during thenavigation procedure. If EMN application 81 determines that digitalprobe 406 has arrived at the target, processing proceeds to step S326,where EMN application 81 determines whether there are more targets to bevisited. If EMN application 81 determines that there are no more targetsto be visited, processing ends. Otherwise, processing returns to stepS302.

FIG. 4 illustrates an example user interface that may be presented byworkstation 80 showing an example view of the 3D model. User interface(UI) 400 includes a button 402 which may be used to select and/or enablethe dynamic 3D lung map view. UI 400 further shows an airway tree 404, adigital probe 406, and a pathway 408.

FIG. 5 illustrates an example of an unadjusted 3D lung map view whichmay be presented by EMN application 81 via UI 400. The unadjusted 3Dlung map view shows the probe 406 within the 3D model, corresponding tothe location of sensor 94 within the patient's airways. Also shown bythe unadjusted 3D lung map view are the airway tree 404, the pathway408, the target 510, the surrounding airways 512, and the pleura 514 ofthe lungs. The unadjusted 3D lung map view may be adjusted manually.

FIG. 6 illustrates an example view of a dynamic 3D lung map view whichmay be presented by EMN application 81. The example dynamic 3D lung mapview shows the same probe 406 and target 510 as the unadjusted 3D lungmap view of FIG. 5 . However, the dynamic 3D lung map view has beenadjusted by zooming in on the 3D model to show the position of probe 406in relation to target 510. The dynamic 3D lung map view has further beenaligned with the tip of probe 406, or a vector 614 from digital probe406 to target 510, and positioned such that pathway 408 and surroundingairways 512 may clearly be seen. A line 614 indicates the line of sightfrom the tip of digital probe 406 intersecting with target 510.

FIG. 7 illustrates an example dynamic 3D lung map view wherein objectshave been hidden or “ghosted out” to more clearly show the objects andcomponents of the 3D model which are relevant to the current procedure,according to an embodiment of this disclosure. Hiding or “ghosting out”objects may involve completely removing such objects from the displayed3D lung map, or such objects may be shown in a different way fromobjects which are not hidden, for example with a higher level oftransparency. The example dynamic 3D lung map view includes airway tree404, probe 406, pathway 408, target 510, surrounding airways 512, andvector 614, as described above with reference to FIGS. 4-6 .

The example dynamic 3D lung map view further shows additional targets718 which have been hidden because they are located outside of theregion of interest, as described above with regard to step S304 of FIG.3 . The example dynamic 3D lung map view also shows that a branch 720 ofairway tree 404 which overlaps with pathway 408 and target 510, and thusobstructs the view of pathway 408 and target 510, has been hidden, asdescribed above with regard to step S308 of FIG. 3 . Additionally, theexample dynamic 3D lung map view shows that a target 722 which does liewithin the region of interest but is not relevant to the currentprocedure has been hidden, as described above with regard to step S312of FIG. 3 . Target 722 may, for example, be a subsequent target on thecurrent pathway to which the tool will be navigated during the currentprocedure, but it is not yet relevant to the procedure because at leastone other target 510 must first be visited. The current pathway may bedivided into two or more portions: a first portion 408 representing theportion of the pathway to be navigated to the current target 510, andadditional portions 708 representing the portion of the pathway leadingto the next target 722 to be visited. The dynamic 3D lung map view alsoshows that other objects, such as markers 724, are hidden because theyare not relevant to the current procedure. Markers 724 may be, forexample, markers indicating the locations where previous biopsies wereperformed.

By using the dynamic 3D lung map view described above during an ENBprocedure, the clinician may be presented with a continuously updatedview of the 3D model which is adjusted as the tool, and thus sensor 94,is moved through the patient's airways. The dynamic 3D lung map viewpresents the clinician with a view of the 3D model from a viewpointwhich clearly shows digital probe 406, and removes objects which mayobscure digital probe 406, airway tree 404, target 510, and/or otherobjects which are relevant to the ENB procedure being performed.

Detailed embodiments of devices, systems incorporating such devices, andmethods using the same as described herein. However, these detailedembodiments are merely examples of the disclosure, which may be embodiedin various forms. Therefore, specific structural and functional detailsdisclosed herein are not to be interpreted as limiting, but merely as abasis for the claims and as a representative basis for allowing oneskilled in the art to variously employ the present disclosure inappropriately detailed structure. While the preceding embodiments aredescribed in terms of bronchoscopy of a patient's airways, those skilledin the art will realize that the same or similar devices, systems, andmethods may be used in other lumen networks, such as, for example, thevascular, lymphatic, and/or gastrointestinal networks as well.

With respect to memory 202 described above in connection with FIG. 2 ,the memory 202 may include any non-transitory computer-readable storagemedia for storing data and/or software that is executable by processor204 and which controls the operation of workstation 80. In anembodiment, memory 202 may include one or more solid-state storagedevices such as flash memory chips. Alternatively or in addition to theone or more solid-state storage devices, memory 202 may include one ormore mass storage devices connected to the processor 204 through a massstorage controller (not shown) and a communications bus (not shown).Although the description of computer-readable media contained hereinrefers to a solid-state storage, it should be appreciated by thoseskilled in the art that computer-readable storage media can be anyavailable media that can be accessed by the processor 204. That is,computer readable storage media includes non-transitory, volatile andnon-volatile, removable and non-removable media implemented in anymethod or technology for storage of information such ascomputer-readable instructions, data structures, program modules orother data. For example, computer-readable storage media includes RAM,ROM, EPROM, EEPROM, flash memory or other solid state memory technology,CD-ROM, DVD, Blu-Ray or other optical storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which can be used to store the desired informationand which can be accessed by workstation 80.

Network interface 208 may be configured to connect to a network such asa local area network (LAN) consisting of a wired network and/or awireless network, a wide area network (WAN), a wireless mobile network,a Bluetooth network, and/or the internet. Input device 210 may be anydevice by means of which a user may interact with workstation 80, suchas, for example, a mouse, keyboard, foot pedal, touch screen, and/orvoice interface. Output module 212 may include any connectivity port orbus, such as, for example, parallel ports, serial ports, universalserial busses (USB), or any other similar connectivity port known tothose skilled in the art.

Further aspects of image and data generation, management, andmanipulation useable in either the planning or navigation phases of anENB procedure are more fully described in commonly-owned U.S.Provisional Patent Application Ser. No. 62/020,177 entitled “Methods forMarking Biopsy Location”, filed on Jul. 2, 2014, by Brown.; U.S.Provisional Patent Application Ser. No. 62/020,238 entitled “IntelligentDisplay”, filed on Jul. 2, 2014, by Kehat et al.; U.S. ProvisionalPatent Application Ser. No. 62/020,242 entitled “Unified CoordinateSystem for Multiple CT Scans of Patient Lungs”, filed on Jul. 2, 2014,by Greenburg.; U.S. Provisional Patent Application Ser. No. 62/020,245entitled “Alignment CT”, filed on Jul. 2, 2014, by Klein et al.; U.S.Provisional Patent Application Ser. No. 62/020,250 entitled “Algorithmfor Fluoroscopic Pose Estimation”, filed on Jul. 2, 2014, by Merlet.;U.S. Provisional Patent Application Ser. No. 62/020,261 entitled “Systemand Method for Segmentation of Lung”, filed on Jul. 2, 2014, by Markovet al.; and U.S. Provisional Patent Application Ser. No. 62/020,258entitled “Cone View—A Method of Providing Distance and OrientationFeedback While Navigating in 3D”, filed on Jul. 2, 2014, by Lachmanovichet al., the entire contents of all of which are hereby incorporated byreference.

While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of particular embodiments. Those skilled in the artwill envision other modifications within the scope and spirit of theclaims appended hereto.

1. (canceled)
 2. A system comprising: a catheter; a sensor; a processorin operative communication with the sensor; and a memory having storedthereon instructions, which, when executed by the processor, cause theprocessor to: determine a position of the catheter based on informationfrom the sensor; present, on a display, a 3D lung map view of a 3D modelshowing at least one planned pathway to at least one target in a lungand the determined position of the catheter; adjust the 3D lung map viewof the 3D model; and alter the transparency of at least part of anobject in the 3D lung map view.
 3. The system of claim 2, wherein theinstructions, when executed by the processor, further cause theprocessor to display a line indicating the line of sight from the tip ofthe catheter in the 3D lung map view of the 3D model.
 4. The system ofclaim 3, wherein the line intersects with the at least one target. 5.The system of claim 2, wherein the sensor is located at the tip of thecatheter.
 6. The system of claim 2, wherein the object is at least oneof a branch of an airway tree which overlaps with the planned pathway,an additional target, a pleura, or a subsequent target on the plannedpathway.
 7. The system of claim 2, wherein the instructions, whenexecuted by the processor, further cause the processor to display avector from the catheter to the at least one target.
 8. The system ofclaim 2, wherein altering the transparency of the at least the part ofthe object forming part of the 3D model includes hiding or ghosting outthe at least the part of the object.
 9. A system for guiding navigationof a catheter in lungs of a patient, the system comprising: a catheter;a display; a processor; and a memory having stored thereon athree-dimensional (3D) model of the lungs of the patient based oncomputer tomography (CT) scan image data, and instructions, which, whenexecuted by the processor, cause the processor to: receive informationfrom a sensor; determine a position of the catheter based on theinformation; display, on the display, the 3D model including at leastone planned pathway, at least one target in the lungs, and thedetermined position of the catheter, from a viewpoint; determine thatthe catheter is approaching the at least one target; and in response todetermining that the catheter is approaching the at least one target,adjust the viewpoint of the 3D model by zooming in on the 3D model. 10.The system according to claim 9, wherein the instructions, when executedby the processor, further cause the processor to: display a userinterface including a button; receive information indicating selectionof a button; and in response to receiving the information indicatingselection of the button, adjust the viewpoint of the 3D model.
 11. Thesystem of claim 9, wherein adjusting the viewpoint of the 3D modelfurther includes moving the viewpoint in relation to the 3D model. 12.The system of claim 9, wherein adjusting the viewpoint of the 3D modelfurther includes rotating the viewpoint around a focal point to improvea 3D perception of the catheter in relation to the 3D model.
 13. Thesystem of claim 9, wherein the instructions, when executed by theprocessor, further cause the processor to present, on the display, atleast a portion of a pleural boundary of the lungs of the patient. 14.The system of claim 9, wherein the instructions, when executed by theprocessor, further cause the processor to: receive a 3D rendering of apleura of the lungs of the patient; and display, on the display, atleast a part of the 3D rendering of the pleura of the lungs of thepatient.